EMS Redesign Process

Deployment/Response Committee

February 23, 2007

Summary Meeting Minutes

Attending:

Name / Agency
Pat Murphy / Central County Fire
Marc Symkowick / Central County Fire
Wade Greene / Redwood City Fire
Jeremy Gerlach / Woodside Fire
Rich Porcelli / South San Francisco Fire
Adrian Anderson / Redwood City Fire and #2400
Jennifer Arkoosh / AMR
Brian Sasaki / PSC
Chief Ron Myers / NCFA, County Fire Chief
Mark Spangler / AMR
Glen Youngblood / EMS
Barbara Pletz / EMS
Michael Mendenhall / AMR
John Kammeyer / Central County Fire
Sandy Reiter / AMR
Bill Ferreira / Pacifica Fire
Chief Armando Muela / Woodside Fire
Bill Bockholt / Bayshore Ambulance
Brent Dubois / AMR
Jeff Higgins / Pacifica Fire
David Bockholt / Bayshore Ambulance
Jan Ogar / EMS
Michael Beaudreau / AMR
Michael March / AMR
Jaime D. Young / PSC
Rick Lamark / AMR
Ian Lee / AMR
Bill O’Callahan / OES
Emil Picchi / JPA
John Wurdinger / Menlo Fire and 2400

Self introductions were made.

We discussed the context for the EMS Redesign process including:

  • Past RFPs
  • State law related to ambulance exclusive operating areas (EOAs) and “201” rights
  • The single countywide EOC (exception South San Francisco which is the only “201” agency in the County)
  • Current EMS redesign process – multiple committees, timelines, inclusive process.
  • The committee process part of redesign needs to be done by October.

One question that arose during the discussion was what would need to occur for more EOAs to be created (e.g. in the south part of the county)? EOAs are created by the “County” and then are approved by the State EMS Authority. Therefore, the request would need to go to the County Board of Supervisors.

Someone pointed out that our purpose here should be directed to making the whole system work better. If we build a good system we won’t need to break up into more EOAs. That is why we are here.

We will be posting the work of various subcommittees on the EMS website.

Communications to committee members will be done via e-mail.

The Mission of this group was identified as:

To identify standards for deployment of resources that would be considered for the next EMS contract.

Ground Rules

The group adopted the follow ground rules:

  • Respect
  • Opinions
  • Agencies
  • Perspectives
  • Put pages/phones on vibrate
  • No PDAs
  • No sidebars
  • No cutting off others who are speaking
  • No filibusters
  • Every idea is OK to talk about
  • Use the Parking Lot for Items to be referred to other Redesign Committees
  • No gossip outside this group
  • What this group decides will be passed up to higher group (Steering)
  • We will agree by consensus
  • We will strive for consensus
  • How many people needed in order to have a meeting? No quorum needed. We will set next meeting at end of each meeting.
  • Data versus perception. If no data is available on a particular thing, the EMS Agency will try to get it.
  • Everyone has an equal voice.

Brainstorming Session followed. Purpose to identify what attendees think is working and what is not working. Putting up the items on list – we won’t be discussing them at this time.

What is working?

  • Seamless 9-1-1
  • Public Safety Communications
  • Early advanced care.
  • Very rapid first response.
  • The sick and injured are transported to hospitals.
  • Quality medical care.
  • Uniform standards.
  • Good paramedics and EMTs.
  • Management team gets along.
  • All stakeholders communicate.
  • People work together well now.
  • Agencies willing to provide mutual aid (e.g. Bayshore and South San Francisco Fire)
  • Level of commitment across the County
  • Oversight piece with the various committees (we try to fix things that aren’t working).
  • Openness to innovation across disciplines
  • Patient data exists in electronic form.
  • Overall participation.

What isn’t working?

  • Not enough ambulances on the street
  • The system status plan is not in place.
  • Patients call 9-1-1 when it isn’t needed. (9-1-1 abuse)
  • Use of resources – we don’t always send just what is needed
  • Ambulances stay too long at hospitals (extended when unneeded).
  • Too heavy a workload for transport units.
  • We don’t use EMTs enough.
  • There is no real time screen shot of the system for supervisors and units.
  • Don’t measure the workload.
  • Ability to get paramedics to staff ambulances.
  • Is this a revenue issue?
  • AMR hiring of fire paramedics for part time was not streamlined.
  • When fire paramedics work part time for AMR they get grief from some firefighters and some AMR crews.
  • The CAD system is antiquated.
  • Fire paramedics don’g get to see the full continuum of care (e.g. don’t go to hospital)
  • The JPA being subordinate to Contractor.
  • The importance of paramedic morale is undervalued.
  • There is no quick way to solve issues between AMR/Fire Agency/JPA.
  • Medical supplies restocking – Refer to Vehicles and Equipment Committee.
  • Lack of staggered shift starts.
  • Is 12:59 too long for ambulance response time standard?
  • Is 90% response time compliance adequate?
  • Information and data is not always communicated.
  • When BLS ambulances are sent to calls they sometimes get pre-empted and an ALS ambulance ends up going.
  • ICS system is not all inclusive.
  • Measurement of system status compliance isn’t frequent enough (should be weekly)
  • Hard to serve areas – ambulances get pulled out of the area.

Meeting Evaluation

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What was went well?

Attendance

Discussion

Representation

Free exchange of information

Professional

No defensiveness

Brainstorming

Clarity

Lots of good ideas

Ability to talk about negative stuff

Respect

Organization

Enthusiasm

Historical perspective

Variety of participants

Didn’t cut off each other

What could be improved?

Spend more time on certain areas

The size of the group (good and bad)

A bigger eraser

Time constraints

Less fluff – more meat and potatoes

Public agencies not taking enough accountability for problems

Next Meeting

March 16

1 pm – 3 pm

Location to be determined
Parking Lot

Medical supplies restocking – Refer to Vehicles and Equipment Committee.